562 THE JOURNAL OF BONE AND JOINT SURGERY UNTREATED INTRAARTICULAR ENTRAPMENT OF THE MEDIAL

Six children with entrapment of the medial epicondyle in the elbow after closed reduction of a posterior dislocation were seen an average of 14 weeks after bjury. The elbows were painful and the average range of flexion was 22#{176}.Two children had ulnar nerve Involvement which recovered after operation. The epicondyle was removed from thejoint and either reattached to the humerus orexcised, and the muscles reattached. Two children had anterior transposition of the ulnar nerve, one for preoperative hyperaestbesia, and the other to relieve tension on the nerve. At follow-up, at an average of15 months after operation, flexion had increased fivefold, none of the children had pain and all were leading normal lives. Dislocation of the elbow in a child is frequently accompanied by avulsion ofthe medial epicondyle which may be trapped in the joint after reduction. This complication may be missed because the fragment is small and is often hidden behind the distal humerus on a radiograph. Pain and limitation of movement ensue. This paper reports the treatment of six children in whom the diagnosis was missed